ArticleFrontiers in immunology2026
Association of the systemic immune-inflammation index with consciousness disturbance in cerebral venous sinus thrombosis: a retrospective cohort study.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Consciousness disturbance (CD) is a severe neurological manifestation of cerebral venous sinus thrombosis (CVST), but the association between the systemic immune-inflammation index (SII) and CD has not been fully characterised. Methods: This retrospective single-centre cohort included 213 adults with imaging-confirmed CVST, of whom 55 (25.8%) had CD during the acute admission. We applied a four-step variable-selection procedure, a ten-seed LASSO-consensus approach, fixed-feature 3 × 10-fold repeated cross-validation, and full-pipeline nested internal validation as a sensitivity analysis. SII was evaluated continuously, by quartiles, and using restricted cubic splines, with additional confounding, component-comparison, interaction, calibration, and incremental-value analyses. Results: In the exploratory standardised three-predictor model, higher SII (OR 4.68, 95% bootstrap CI 2.98-8.64; P <0.001), intracerebral haemorrhage (OR per 1 SD 1.62, 1.14-2.40; P = 0.008), and lower platelet count (OR 0.39, 0.23-0.57; P <0.001) showed conditional associations with CD. Logistic regression using eight LASSO-consensus features achieved AUROC 0.840 ± 0.092 with a train-test gap of 0.028 in the prespecified fixed-feature repeated cross-validation. A like-for-like fixed-feature logistic-regression comparison showed that the three-predictor model retained similar discrimination to the eight-feature model (mean per-fold AUROC 0.837 ± 0.091 vs. 0.840 ± 0.092) with a smaller train-test gap (0.004 vs. 0.028). The full-pipeline nested sensitivity analysis yielded AUROC 0.800 (95% CI 0.717-0.869). Patients in the highest SII quartile had 11.62-fold higher fully adjusted odds of CD than those in the lowest quartile (95% CI 2.82-47.87; P-trend = 0.0004). The spline supported an overall association (P <0.001) but not statistically significant nonlinearity (P = 0.151). In component sensitivity analyses, SII had greater unadjusted discrimination than neutrophil count, lymphocyte count, or platelet count (AUROC 0.783 vs. 0.638, 0.575, and 0.575, respectively). Conclusions: Higher acute-phase SII was associated with CD in this cohort. The fixed-feature and full-pipeline nested analyses provide complementary internal evidence; prospective, temporally resolved, multicentre external validation is required before clinical use.
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